Newsletter No. 9 – 9 July, 2014

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At the joint meeting of the North American Association of Cancer Registries (NAACCR) and the International Association of Cancer Registries (IACR) in Ottawa last month, Prof Michel Coleman and Dr Claudia Allemani presented preliminary results from the CONCORD-2 study. More than 2,500 data sets from 279 cancer registries in 67 countries have been checked and analysed.

The first phase of quality control was to check whether each variable in each tumour record in each data file was coded in compliance with the protocol. “Protocol adherence” reports were sent to all registries, and many registries submitted revised data sets. All data sets are now compliant with protocol.

The second phase of quality control was a set of checks on the internal coherence of each tumour record (valid dates, logical date sequence, sex-site, site-morphology checks, etc). This phase generated some 2,500 tables documenting exclusion of patient records and creation of the final data sets for survival analysis. This phase is also complete, and “exclusion reports” have been sent to all registries.

Cancer registries and data sets received and checked for quality control, by continent

Continent

Registries participating

Data sets received

Data sets checked
Africa            10                 82                 82
America (Central and South)            27               181               181
America (North)            57               570               570
Asia            60               472               472
Europe          128            1,138            1,138
Oceania              7                 70                 70
Total          279            2,513            2,513

 

Of the 28.7 million records received, 26.8 million records were considered eligible. Of those, 25.8 million patient records have been included in the survival analyses. Many of the ineligible records were for in situ cancers, but those records had been specially requested so we could compare the intensity of screening in each population. Reasons for excluding patients whose data were eligible for inclusion in survival analyses ranged from missing critical information (such as vital status or sex) to death-certificate-only cases. The largest group of patient records (43.7%) came from cancer registries in North America.

 

Number of cancer patients included in the CONCORD-2 study by continent

(NB: provisional figures, susceptible to withdrawal, exclusion and other changes)

Continent

No.

%
Africa

12,711

<0.1
America (Central and South)

349,052

1.4
America (North)

11,282,731

43.7
Asia

3,284,658

13.0
Europe

10,061,976

39.0
Oceania

837,924

3.2
Total

25,829,052

100.0

In addition to checking the cancer data, 6,614 life tables have been produced to adjust for background mortality in each country or registry territory by age, sex, race (New Zealand, Israel, US) and calendar year. This is crucial for international comparison of survival, since background mortality varies widely between and within countries, and over time.

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CONCORD questionnaire

We have received questionnaires from most of the registries that have submitted data. Thank you! The questionnaires provide important data about cancer registry operations such as procedures for follow-up. The information will help in the interpretation of international cancer survival comparisons. If you have not yet completed the questionnaire, you will need to do this, either online or as a Word document that you can return by email:

https://www.survey.lshtm.ac.uk/concord2

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CONCORD Steering Committee and Working Group – 12 travel fellowships

Thirteen of the 27 members of the CONCORD Steering Committee met in Ottawa, Canada, on 24 June 2014 to discuss strategic plans and future for the programme, during the combined NAACCR/IACR conferences. Technical difficulties prevented Prof David Currow from joining the meeting by Skype from Sydney, Australia.

A full meeting of the CONCORD Working Group was held the next day, 25 June. The meeting brought together representatives from cancer registries in 62 countries. Cancer Research UK (CRUK) funding enabled us to provide full travel fellowships for 12 registry scientists and Steering Committee members from Algeria, Brazil, Chile, China, Cuba, France, Latvia, Lithuania, Mongolia, Nigeria, Russian Federation and Thailand to attend both the NAACCR/IACR conferences and the CONCORD meetings.

The Working Group discussed the preliminary results of survival analyses and plans for the first major publication in the near future.

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Publications

Two of the three high-resolution studies that developed from the first CONCORD study have now been published, examining the reasons for US-European disparities in survival from colorectal and breast cancer. We anticipate publication of the prostate high-resolution study within the next few months:

  1. Allemani C, Rachet B, Weir HK, Richardson LC, Lepage C, Faivre J, Gatta G, Capocaccia R, Sant M, Baili P, Lombardo C, Aareleid T, Ardanaz E, Bielska-Lasota M, Bolick S, Cress R, Elferink M, Fulton JP, Galceran J, Gozdz S, Hakulinen T, Primic-Zakelj M, Rachtan J, Diba CS, Sanchez MJ, Schymura MJ, Shen T, Tagliabue G, Tumino R, Vercelli M, Wolf HJ, Wu XC, Coleman MP. Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study. BMJ Open 2013; 3: e003055
  2. Allemani C, Sant M, Weir HK, Richardson LC, Baili P, Storm H, Siesling S, Torrella-Ramos A, Voogd AC, Aareleid T, Ardanaz E, Berrino F, Bielska-Lasota M, Bolick S, Cirilli C, Colonna M, Contiero P, Cress RD, Crocetti E, Fulton JP, Grosclaude P, Hakulinen T, Izarzugaza I, Malmström P, Peignaux K, Primic-Žakelj M, Rachtan J, Safaei Diba C, Sanchez M-J, Schymura MJ, Shen T, Traina A, Tryggvadóttir L, Tumino R, Velten M, Vercelli M, Wolf HJ, Woronoff A-S, Wu X, Coleman MP. Breast cancer survival in the US and Europe: a CONCORD high-resolution study. Int J Cancer 2013; 132: 1170-81

The Lancet has published three articles arising from the World Oncology Forum held in Lugano, Switzerland, in October 2012, as a Lancet Series entitled: “The Cancer Wars”. The third article provides the background and rationale for the CONCORD programme:

  1. Vineis P and Wild CP. Global cancer patterns: causes and prevention.  http://linkinghub.elsevier.com/retrieve/pii/S0140673613622242
  2. Hanahan D. Rethinking the war on cancer.http://dx.doi.org/10.1016/S0140-6736(13)62226-6
  3. Coleman MP. Cancer survival: global surveillance will stimulate health policy and improve equity. Lancet 2014; 383: 564-73 http://linkinghub.elsevier.com/retrieve/pii/S0140673613622254

The last article includes the background and rationale for the CONCORD programme.

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Scientific meetings and conferences

Preliminary survival results were presented during a plenary session at the IACR meeting in Ottawa. Population-based survival for Canada and the US is high, relative to many other parts of the world. For each of the 10 cancers investigated, survival is similar in the US and Canada. Survival improved steadily between 1995-99, 2000-04 and 2005-09 for most of these cancers, not just in North America, but with a few notable exceptions, world-wide.

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Teaching and capacity-building

Ottawa (Canada) 23 June: Workshop on cancer survival

Prof Michel Coleman, Dr Bernard Rachet, Dr Claudia Allemani, Dr Hannah Weir (Centers for Disease Control and Prevention, CDC) and Dr Diane Nishri (Cancer Care Ontario) ran a one-day workshop on cancer survival in Ottawa on 23 June 2014, as part of the NAACCR/IACR conference programme. The workshop provided an introduction to the principles, methods and applications of cancer survival. It was attended by 30 participants.

 

London (UK) and Lyon (France), 30 June – 4 July 2014

The 9th annual short course “Cancer survival: principles, methods and applications” was run by the Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine (LSHTM).

The London course is run in collaboration with the International Agency for Research on Cancer (IARC) in Lyon, France. The Agency’s regular one-week summer course on cancer registration was held during 16-22 June 2014, and its two-week course on cancer epidemiology ran from 23 June to 4 July 2014.

Cancer Survival Group staff taught in Lyon in the first and third weeks, and IARC sent a faculty member to teach on the LSHTM course.

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Funding

The following agencies have committed funding or personnel to the CONCORD programme:

  • Canadian Partnership Against Cancer (Toronto), two years 2013-14
  • Cancer Focus Northern Ireland (Belfast), researcher seconded part-time to London 2013-14
  • Cancer Institute New South Wales (Sydney), two researchers seconded part-time
  • Cancer Research UK (London), four years 2013-16
  • Centers for Disease Control and Prevention (Atlanta), three years 2012-15
  • Children with Cancer UK (London), PhD student 2013-2015
  • Fondation de France (Paris), full-time post-doctoral researcher 2014-2015
  • Swiss Re (London), three years 2012-14
  • Swiss Cancer Research foundation (Bern), three years 2013-16
  • Swiss Cancer League (Bern), three years 2013-16

Previous funding agencies:

  • University of Kentucky (Lexington KY)

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Personnel working on CONCORD-2

  • Dr Michel Coleman MD, Professor of Epidemiology and Vital Statistics
  • Dr Claudia Allemani PhD, Lecturer in Cancer Epidemiology
  • Dr Audrey Bonaventure, MD PhD, Clinical Lecturer
  • Helena Carreira MPH, Research Fellow
  • Rhea Harewood MSc, Research Fellow
  • Dr Jérémie Jégu, MD PhD, Research Fellow (from September 2014)
  • Devon Spika MSc, Research Fellow
  • Dr Xiao-Si Wang PhD, Research Fellow
  • Jane Ahn MSc, Data Manager
  • Natalia Sanz BA, Programme Manager
  • Tanisha Lewis BA, Administrative Assistant
  • Dr Finian Bannon PhD (Cancer Focus Northern Ireland, Belfast, UK), seconded part-time
  • Dr Matt Soeberg PhD (Cancer Institute NSW, Sydney, Australia), seconded part-time
  • Hui You MSc (Cancer Institute NSW, Sydney, Australia), seconded part-time
  • Dr Renata Abrahão MD (doctoral student, Children with Cancer)
  • Melissa Matz MSc (doctoral student)

Dr Jérémie Jégu will join the CONCORD team as a Research Fellow from September 2014.

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Endorsements for the CONCORD programme

More than 30 agencies have now provided funding, scientific personnel or written endorsement for the CONCORD programme, emphasising the wide support for global surveillance of cancer survival:

  • Asociación Española contra el Cáncer (aecc) (Madrid, Spain)
  • Association of European Cancer Leagues (ECL) (Brussels, Belgium)
  • British Embassy in Algiers (Algeria)
  • Canadian Association of Provincial Cancer Agencies (CAPCA) (Toronto, Canada)
  • Canadian Council of Cancer Registries (Toronto, Canada)
  • Canadian Partnership Against Cancer (CPAC) (Toronto, Canada)
  • Cancer Focus Northern Ireland (Belfast, UK)
  • Cancer Institute New South Wales (Sydney, Australia)
  • Cancer Research UK (London, UK)
  • Centers for Disease Control and Prevention (CDC) (Atlanta, USA)
  • Children with Cancer UK (London, UK)
  • Danish Cancer Society (Copenhagen, Denmark)
  • European CanCer Organisation (ECCO) (Brussels, Belgium)
  • European Institute for Women’s Health (Dublin, Ireland)
  • Fondation de France (Paris, France)
  • International Agency for Research on Cancer (IARC) (Lyon, France)
  • International Atomic Energy Agency (IAEA) (Vienna, Austria)
  • International Network for Cancer Treatment and Research (INCTR) (Brussels, Belgium)
  • Israel Centre for Disease Control (Tel-Hashomer, Israel)
  • Jolanta Kwaśniewska’s Foundation (Warsaw, Poland)
  • Members of the European Parliament Against Cancer (MAC) (Brussels, Belgium)
  • National Cancer Institute, Center for Global Health (NCI) (Washington DC, USA)
  • National Institute for Health Research (NIHR) Consumer Liaison Group (Leeds, UK)
  • National Institute for Cancer Epidemiology and Registration (NICER) (Zürich, Switzerland)
  • North American Association of Central Cancer Registries (NAACCR) (Chicago, USA)
  • Organisation for Economic Co-operation and Development (OECD) (Paris, France)
  • Swiss Cancer League (Zürich, Switzerland)
  • Swiss Cancer Research foundation (Bern, Switzerland)
  • Swiss Re (London, UK)
  • Union for International Cancer Control (UICC) (Geneva, Switzerland)
  • WHO Regional Office for Europe (WHO-EURO) (Copenhagen, Denmark)
  • World Bank

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